| Benning Road Primary Care Pc | |
|
1647 Benning Rd Ne Suite 304 Washington DC 20002-4569 | |
| (202) 397-2200 | |
| (202) 397-2688 |
| Full Name | Benning Road Primary Care Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1647 Benning Rd Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Ismail Mustapha Kalokoh (CEO) |
| Authorized Official Contact | 2023972200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benning Road Primary Care Pc Po Box 3703 Capitol Heights MD 20791-3703 Ph: (202) 397-2200 | Benning Road Primary Care Pc 1647 Benning Rd Ne Suite 304 Washington DC 20002-4569 Ph: (202) 397-2200 |
| NPI Number | 1518230515 |
|---|---|
| Provider Enumeration Date | 02/22/2012 |
| Last Update Date | 02/22/2012 |
| Medicare PECOS PAC ID | 0749442127 |
|---|---|
| Medicare Enrollment ID | O20120501000342 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518230515 | NPI | - | NPPES |
| 017134100 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD21581 (District Of Columbia) | Primary |
| Provider Name | Ismail Kalokoh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912959073 PECOS PAC ID: 3779626809 Enrollment ID: I20100211000278 |
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